Axelrod ts, cheng slt 1995 complex dislocations of the distal radioulnar joint. Anatomy and biomechanics of the distal radioulnar joint. Atlas of distal radius fractures free pdf download. Distal radius fracture is the most common fracture of the upper extremity, with an annual incidence of 2 to 4 per 1,000 persons. Figure w12 anterior volumerendered 3d reformatted image from a multidetector ct examination allows improved appreciation of the degree of fracture displacement of the distal radius, allowing the clinician to anticipate surgical findings frequently, subtle radiographic lucencies of the distal radius may simulate fractures and are a cause for inconclusive, or even incorrect, reporting. This exhibit depicts the closed reduction of a left distal radius fracture.
Several therapeutic options exist, including orthopedic treatment and internal fixation with pins intra and extrafocal, external fixation which may or may not bridge the wrist, and different internal fixation techniques with dorsal or palmar plates using or not, locking. A colles fracture is the most common form of distal radius fracture, accounting for 90% of distal radius fractures. The distal radius and distal ulna form a threecolumn biomechanical construction. The treatment of comminuted, intraarticular distal radius fractures has been evolving to include a multitude of techniques for internal fixation 2, 3. Closed reduction of left distal radius fracture print. Distal radius fractures are one of the most common injuries encountered in orthopedic practice. Influence of ulnar translation of the radial shaft in. The medial surface of the distal radius is concave, forming the sigmoid notch of the distal radioulnar joint druj. Distal radius fractures modified carpal tunnel approach feat.
Clinical function and outcome do not appear to be associated with repair of a fracture of the base of the ulnar styloid. A comprehensive offering of volar plates are available in narrow, standard, and wide as well as multiple shaft lengths. The distal end of the radius forms two palpable points, radially the styloid process and listers tubercle on the ulnar side. Smith described fracture of distal radius with forward displacement. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. Bone geometry, density and strength indices of the distal. In addition, the dorsally displaced distal fragment causes a characteristic deformity of the distal forearm, known as the. The titanium wrist plating system technique is designed for fixation of intraarticular and extraarticular fractures, osteotomies, as well as nonunions and malunions of the distal radius.
Luber md, in fractures and injuries of the distal radius and carpus, 2009. The plate should be placed slightly below the distal edge of the radius to support the volar articular fracture. The lack of structural support remains a challenge in the treatment of comminuted distal radius fractures. Operative treatment options are open reduction and internal fixation or. A residual ulnar translation deformity of the radial shaft in distal radius fractures has the potential to cause distal radioulnar joint druj instability when triangular fibrocartilage complex tfcc injury is also present, because it may result in. Distal radius anatomy applied to the treatment of wrist.
Choose the appropriate implant according to patient anatomy and fracture pattern. Distal radius fractures have been a common affliction for millennia, but their treatment is a more recent development as a result of human erudition. Korean type distal radius anatomical volar plate system clinics in orthopedic surgery vol. Fractures of the distal radius are the most common fractures in the human body. The titanium volar plates are available in a wide array of sizes narrow, standard, and wide and in multiple shaft lengths. This elevated posture likely represents a significant risk factor that has played a role in drfs being the most common fracture treated by physicians. Abraham colles is credited with description of the most common fracture pattern affecting distal end radius in 1814, and is classically named after him. W1 role of advanced imaging in distal radius fractures. It has been reported that the distal interosseous membrane diom of the forearm constrains the dorsal dislocation of the distal radius. It is a long bone, prismshaped and slightly curved longitudinally the radius is part of two joints. Fully revised and expanded, with new illustrations and radiographs and new chapters on the distal radioulnar joint, late complications and future fracture techniques, no orthopaedic surgeon can be without this comprehensive and complete guide to the treatment of what are remarkably complex. Fractures of distal radius account for up to 20% of all fractures treated in emergency department. The distal radius receives its diaphyseal intramedullary blood supply on its ulnar surface from the anterior and posterior interosseous arteries through one or more nutrient arteries.
A comprehensive offering of volar plates are available in narrow, standard, and. Influence of ulnar translation of the radial shaft in distal. We conclude with a series of questions the radiologist should address in the initial description of fracture involving the distal radius. Symptoms include pain, bruising, and rapidonset swelling. The traditional treatment of distal radius fractures was either nonoperative, with closed reduction and cast immobilisation, or operative. Apr 22, 2016 distal radius plate and lcp the locking plate has changed the way to treat distal radial fractures 40. Fully revised and expanded, with new illustrations and radiographs and new chapters on the distal radioulnar joint, late complications and future fracture techniques, no orthopaedic surgeon can be without this comprehensive and complete.
While immobilization has served as the only available treatment for most of our history, many advances have been made in the management of distal radius fractures over the last century as the. Specific qualitative and quantitative features of the distal radius fracture apparent on the radiograph are discussed. The reduction of the fracture was achieved by traction with finger traps. A study of 20 patients, found that grip strength correlated with all tasks in the jebsen hand test, but motion correlated only with lifting large objects 26. Distal radius plate and lcp the locking plate has changed the way to treat distal radial fractures 40. Choice of short and long distal threads for interfragmentary application in a wide variety of indications innovative technologies and outstanding thread properties cannulated and selfdrilling screw design excellent cutting behavior and low insertion torque reduce the risk of bone fragment displacement medartis screw tip with. The implants of the alians radius range are intended for the fixation of extra and intraarticular fractures as well as distal radius osteotomies in adults. A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. The distal radius plates unique distal articular plate arms. Initial kwire placement can be done with a traditional crosspinning. Distal radius fractures represent approximately one sixth20% of all fractures distal radius fractures occur through the distal metaphysis of the radius may involve articular surface. Intraarticular fractures of the radius can be arthroscopically assessed, and reduction of the articular components and assessment and repair of ligamentous injury can then be undertaken. Size c 186050184 4x50lx18tl c 186060204 4x60lx20tl c 186070204 4x70lx20tl l c 186080204 4x80lx20tl c 186100204 4x100lx20tl instruments jig for distal radius fixator part no. The distal radius plate instrument and implant set tg pdf.
Bones to fixate scaphoid trapezium trapezoid capitate hamate triquetrum lunate radius scaphoid lunate radius. Distal radius anatomy applied to the treatment of wrist fractures by plate. Colles fracture specifically is defined as metaphyseal injury of cortico. It consists of the carpus, distal ulna and distal radius. Chung and colleagues 1 assessed 49 patients 1 year after a distal radius fracture. We conclude with a series of questions the radiologist should address in the initial description of. Along with the proximal and distal radioulnar articulations, an interosseous membrane originates medially along the length of the body of the radius to attach the radius to the ulna. The distal radius fracture drf is an injury that predates our species, with a significant milestone in our evolution being the transition to bipedal ambulation by australopithecus.
We report five cases of nonunion of the distal radius. Compact distal radius system synthes 3 lcp compact distal radius instrument and implant set stainless steel 01. The intermediate column is the medial part of the distal radius, with the lunate fossa and the sigmoid notch. The insertion of the brachioradialis may be released. Furthermore, a fresh look at distal radius biomechanics shows that the loads experienced by the distal radius vary greatly.
The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. Dec 01, 2015 smith described fracture of distal radius with forward displacement. Treatment of distal radius fractures with volar locking. In patients for whom function is a priority, anatomic reduction and stable fixation are prerequisites for good outcomes. Distal radius fractures are the most common fractures of the human skeleton, with about ten per cent of the population sustaining a fracture at some point in their life. The resulting peripheral configuration of kwires should leave the center of the distal radius free for eventual placement of the conventus cage dr, as shown in the diagram to the left. A screw of 4mm diameter was inserted into the ulnar corner of the distal radius to apply loading in the dorsal and palmar directions. The use of bone cement in difficult distal radius fractures. Review article external fixation of distal radius fractures. In three patients, union of the distal radius was obtained. The radial column is the lateral radius with the scaphoid. Distal radius external fixator distal radius fixator part no. All five patients were heavy tobacco smokers and three had a history of alcohol abuse.
In recent years, great changes have taken place both in the treatment options of the distal radius and the patient demands which have increased. In 1814, abraham colles published the first narrative of distal radius fractures in which the injury was described as a dorsally angulated fracture that healed with perfect free dom of motion. Korean type distal radius anatomical volar plate system. Pdf combined fractures of the distal radius and scaphoid. The distal radius has a broad metaphysis with a sloping distal articular surface that demonstrates medial inclination and volar tilt and has concave articular facets for the scaphoid and lunate. Juxtaarticular plates may be used for more complex fractures ao types b3, and c1c3. Data were included for two regions of interest roi in the distal radius. Jan 10, 2015 introduction distal radius fracture represent approximately one sixth of all fractures there are three main peaks of fracture distribution,children aged 514 years,male aged under 50 years and females over the age of 40 years distal radius fractures occur through the distal metaphysis of the radius may involve articular surface frequently. Initial kwire placement can be done with a traditional crosspinning technique. Initial assessment includes a history of mechanism of injury, associated injury and appropriate. The treatment of distal radius fractures with volar locking plates is the only treatment currently available that allows immediate postoperative wrist motion without the need for additional fixation in most cases. Most of these fractures can be recognized by the marked swelling, pain, and tenderness of the wrist. Medartis ag hochbergerstrasse 60e 4057 baselswitzerland.
Each chapter offers a comprehensive guide to the diagnosis and treatment of a specific fracture, including possible complications. Distal radius fractures represent approximately one sixth20% of all fractures distal radius fractures occur through the distal metaphysis of the radius may involve articular surface frequently involves the ulnar styloid 4. Arthrex arthrex distal radius plate surgical technique. Passive druj mobility was tested by translating the distal radius relative to the ulna in a dorsopalmar direction with a load of 19. In many patients, conservative treatment has shown poor functional results, despite satisfactory radiologic findings. The evolution of distal radius fracture management a. During the last years there have been considerable changes in the assessment and management of distal radius fractures.
Introduction distal radius fracture represent approximately one sixth of all fractures there are three main peaks of fracture distribution,children aged 514 years,male aged under 50 years and females over the age of 40 years distal radius fractures occur through the distal metaphysis of the radius may involve articular surface frequently. Combined fractures of the distal radius and scaphoid are uncommon, are usually the result of a highenergy trauma and there is no consensus regarding their optimal management. Lee, md, new york, ny presents the arthrex volar distal radius plate technique. Recent work by rikli et al, however, has shed new light on this point. Calcium phosphate and calcium sulfate bone cement has been used in other fracture locations in addition to fixation and has been shown to allow for retention of reduction in difficult cases. While longterm outcomes and complications are still being evaluated, a significant challenge in the treatment of these fractures is structural support in the presence of soft and sometimes osteoporotic metaphyseal bone.
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